title: Domperidone effective in preventing rivastigmine-related gastrointestinal disturbances in patients with Alzheimer's disease.
abstract: OBJECTIVE
  While acetylcholinesterase inhibitors, such as donepezil, galantamine, and rivastig-mine, are beneficial in treating behavioral symptoms of patients with Alzheimer's disease (AD), their dose-limiting effects include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. We aimed to predict the occurrence of these gastrointestinal disturbances with rivastigmine therapy for optimal drug choice and improved compliance.
  
  
  METHODS
  Thirty patients with mild-to-moderate AD (scores 10-22 on the MiniMental State Examination) were administered a rivastigmine 18 mg patch with domperidone 30 mg (RWD) and without domperidone (RWOD; n = 15 each) for 20 weeks. Gastrointestinal disturbances were evaluated using a frequency scale for symptoms of gastroesophageal reflux disease (FSSG), Bristol stool form scale, laboratory data (hemoglobin, albumin, total cholesterol), body weight, and amount of food intake.
  
  
  RESULTS
  After 12 weeks, FSSG scores were higher in the RWOD group compared to baseline scores; however, no significant differences were noted between the RWD and RWOD groups. We then subdivided each group based on high and low baseline scores; the RWOD high-score (≥4) subgroup showed increased FSSG after 12 weeks compared with the baseline score. In both RWD and RWOD groups, the low-score (≤3) subgroups showed no changes during the dose-escalation phase.
  
  
  CONCLUSIONS
  For AD patients with higher FSSG scores at baseline, domperidone was effective in preventing rivastigmine-related gastrointestinal disturbances.
authors.affiliation: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kano
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Urita
authors.forename: Hirono
authors.initials: H
authors.lastname: Ito
authors.forename: Takanori
authors.initials: T
authors.lastname: Takazawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kawase
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Murata
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hirayama
authors.forename: Ken
authors.initials: K
authors.lastname: Miura
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Tetsuhito
authors.initials: T
authors.lastname: Kiyozuka
authors.forename: Jo
authors.initials: J
authors.lastname: Aoyagi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Iwasaki
keywords: Alzheimer’s disease; acetylcholinesterase inhibitors; domperidone; gastroesophageal reflux disease; gastrointestinal disturbance; rivastigmine